Links to other sites on the WebMedscape's Managed Care MedPulse 7-Sep-01
______________________________________________________________________
>>> MEDSCAPE's Managed Care MedPulse(R) <<<
http://managedcare.medscape.com/
Read it here
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Social HMOs: An Answer for an Aging Population
A recent report to Congress criticized SHMOs for failing to demonstrate improved health outcomes. But proponents say the study failed to recognize plans' success in keeping elderly people independent.
http://www.medscape.com/42445.rhtml?srcmp=mc-090701
Read it here
Managed Care, Parity, Medicaid Expansion High on Advocates' Wish List
When Congress returns from its summer break Sept. 3, mental health advocates say they will redouble efforts in the session's final three months toward gaining mental health parity and family opportunity laws, as well as
http://www.medscape.com/42457.rhtml?srcmp=mc-090701
Read it here
--Managed Care/Insurers--
Consumers Union Criticizes House Version of Patients' Bill of Rights
Consumers Union, the nonprofit publisher of Consumer Reports, cautioned on Thursday that the US House of Representatives' version of the patients' bill of rights contains several 'hidden hurdles' that would make it difficult for patients to exercise their rights.
http://www.medscape.com/42271.rhtml?srcmp=FM-090701
Read it here
Americans Support Limited Right to Sue HMOs
A national poll released Thursday shows continued strong support among Americans for managed care reform and also reveals that a large majority would be comfortable with a limited right to sue health plans for improperly denied care.
http://www.medscape.com/42276.rhtml?srcmp=FM-090701
Read it here
Maryland Levies Fines Against Five Health Plans
The Maryland Insurance Administration has taken disciplinary action against five health insurers for a variety of violations and has ordered the plans to pay a total of $1.4 million in penalties.
http://www.medscape.com/42419.rhtml?srcmp=mc-090701
Read it here
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ORGASM INDUCED ASTHMA?
Believe it or not, it is possible. Listen to what CBS Healthwatch?s expert has to say on this, and several other Asthma related issues.
http://cbshealthwatch.medscape.com/cx/viewarticle/225529
Read it here
8/01:
CALIF. SUPREME COURT DECIDES HMO CASE The healthcare for several million patients is provided by Medicare-authorized HMOs. http://moneymedicine.medscape.com/40933.rhtml?srcmp=fin-082401 Read it Here
BLUE CROSS AGREES TO REVIEW OF BEHAVIORAL HEALTH CLAIM DENIALS As part of a settlement of a law-suit against Blue Cross and Blue Shield of Minnesota over access to coverage for addictions and mental illness, the state attorney general's office has won a concession that it believes is unprecedented in behavioral managed care. http://managedcare.medscape.com/42009.rhtml?srcmp=mc-082401 Read it Here
Fed bill would override state laws granting greater protections to consumers. Read it Here
HMO LAWSUIT COULD REPRESENT 50 MILLION PEOPLE A small group of HMO subscribers asked a US judge on Tuesday to certify their fraud claims against the nation's largest managed care companies as a class action that could represent in excess of 50 million people. http://managedcare.medscape.com/40902.rhtml?srcmp=mc-072701 Read it Here
TOP HMO EXECUTIVES EARNED MILLIONS LAST YEAR
The highest paid executives at 10 of the nation's largest for-profit
health plans each made an average of $11.7 million last year, according
to a report released Thursday morning.
http://managedcare.medscape.com/39457.rhtml?srcmp=mc-062201
Read it Here
Democrats debate patients' rights plan June 9, 2001 Posted: 10:15 AM EDT (1415 GMT)
WASHINGTON (AP) -- Senate Democrats are bracing for a fight over a patients' rights plan, accusing the Bush administration of pushing for a weak law designed to protect health corporations.
In the Democrats' weekly radio address Saturday, Sen. John Edwards, D-North Carolina, said President Bush needs to break his alliance with big business.
"Today, HMOs and insurance companies are treated differently than just about any other business or person in America," Edwards said. "Unlike doctors, nurses and hospitals, HMOs that make deadly mistakes cannot be held accountable in a court of law."
The Republican bill would allow patients to sue health plans when necessary medical treatment is denied, but it limits lawsuits to federal courts and caps damages at $500,000. Supporters say the caps would keep insurers from raising rates.
Democrats are focusing on a plan to allow lawsuits in state and federal courts and awards of up to $5 million. They say any premium increases are a small price to pay for the new rights to care patients would get.
"Our bill can't become law -- and you can't get the quality health care you deserve -- without support from President Bush," Edwards said. "In my opinion, the bill the president likes is not a patients' protection bill. It's what a Republican congressman I know called an HMO protection bill."
5/28/01
___________________________________ NEWS ______________________________
WASHINGTON REPORT
AMA JOINS OPPOSITION TO CENTRIST MANAGED CARE BILL
The AMA officially announced its opposition to the purported compromised
'patients' bill of rights' introduced last week by Sens. Bill Frist,
R-Tenn., John Breaux, D-La., and James Jeffords, R-Vt.
http://managedcare.medscape.com/38175.rhtml?srcmp=mc-052501
Read it Here
MANAGED CARE/INSURERS
HEALTH PLANS RARELY REPORT BAD DOCTORS TO FEDERAL DATABANK
Eighty-four percent of managed care organizations have never reported an
adverse action against a healthcare practitioner to the federal
repository for disciplinary records and malpractice actions, a new
government study finds.
http://managedcare.medscape.com/38061.rhtml?srcmp=mc-052501
Read it Here
MANAGED CARE PLANS SHIFT TO ACCOMMODATE COMPLAINTS
Managed care has changed significantly in the past few years, in
response to a 'hostile environment' on several fronts, a researcher told
a conference on the future of managed care Friday.
http://managedcare.medscape.com/38093.rhtml?srcmp=mc-052501
Read it Here
MANAGED CARE NOT DEAD YET, SAY CEOS
Despite chatter in policy circles about employers moving away from
insurance to 'defined contributions,' and consumers designing their own
plans on the Internet, managed care will continue to play a key role in
the nation's healthcare system, executives of four major health plans
told managed care conference participants.
http://managedcare.medscape.com/38095.rhtml?srcmp=mc-052501
Read it Here
FEAR LEADS PSYCHIATRISTS TO SELF-MEDICATE DEPRESSION
Nearly half of all surveyed psychiatrists suffering from depression say
that they would rather treat themselves than risk a record of mental
illness on their health insurance, and an even higher percentage say
they would treat a depressed friend or relative.
http://managedcare.medscape.com/38208.rhtml?srcmp=mc-052501
Read it Here
INTERNET HEALTH
HI-ETHICS TO ADOPT WEB SITE ACCREDITATION STANDARDS
Hi-Ethics Inc., a consortium of health Internet sites and content
providers, said on Monday that its members would use a set of
accreditation standards developed by URAC to demonstrate their
commitment to quality.
http://managedcare.medscape.com/38094.rhtml?srcmp=mc-052501
Read it Here
RELEVANT HEALTH CONTENT LOW ON INTERNET SEARCH ENGINES
People searching for health information on the Internet may have a hard
time finding the facts they want.
http://managedcare.medscape.com/38226.rhtml?srcmp=mc-052501
Read it Here
HEALTHCARE STAKEHOLDERS UNVEIL EHEALTH INITIATIVE
An alliance of healthcare companies and institutions today announced the
launch of an advocacy and trade organization whose mission is to promote
rapid adoption of the Internet and other emerging technologies to
modernize healthcare delivery.
http://managedcare.medscape.com/38097.rhtml?srcmp=mc-052501
Read it Here
CONSUMERISM, NOT MANAGED CARE, WILL DEFINE US HEALTHCARE
Managed care helped keep healthcare inflation at bay during the 1990s,
but its restrictions have so infuriated doctors and patients that
proponents of the strategy are now in full retreat, a health economist
argues in The Journal of the American Medical Association.
http://managedcare.medscape.com/38133.rhtml?srcmp=mc-052501
Read it Here
WE GIVE CREDIT - WHEN CREDIT IS DUE
INSTANT, PRINTABLE CME CREDITS NOW AVAILABLE ONLINE
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5/13/01
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___________________ NEW FEATURE ARTICLES THIS WEEK ____________________
MANAGED CARE/INSURERS
CALIFORNIA COURT ALLOWS SENIORS TO SUE HMOS
Medicare beneficiaries in California may sue their HMOs for refusing
costly medical treatment, the California Supreme Court ruled on
Thursday.
http://managedcare.medscape.com/37460.rhtml?srcmp=mc-051101
Read it Here
MIAMI JUDGE HEARS CLASS ACTION MOTION IN HMO SUITS
America's biggest health insurers battled here in federal court on
Monday against consolidating into a single class-action suit the claims
of an estimated 600,000 doctors accusing the insurers of cheating on
fees.
http://managedcare.medscape.com/37551.rhtml?srcmp=mc-051101
Read it Here
BLUES PLANS ALMOST DOUBLE NET GAINS IN 2000
The nation's 45 independent Blue Cross and Blue Shield health plans
recorded net gains totaling $2.4 billion in 2000, an increase of more
than $1 billion over the previous year, according to statistics compiled
by the Blue Cross and Shield Association (BCBSA).
http://managedcare.medscape.com/37601.rhtml?srcmp=mc-051101
Read it Here
QUALITY OF CARE/MEDICAL ERRORS
OKLAHOMA PROVIDES LEGAL PROTECTION FOR DRUG-ERROR REPORTS
Oklahoma is the first state in the nation to specifically bar
information reported to MedMARx, a national medical errors database,
from being introduced as evidence in a legal proceeding, US Pharmacopeia
(USP) announced this week.
http://managedcare.medscape.com/37727.rhtml?srcmp=mc-051101
Read it Here
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___________________________________ NEWS ______________________________
WASHINGTON NEWS (4/01)
HHS TASK FORCE TO CREATE WEB-BASED PATIENT SAFETY REPORTING SYSTEM
The Bush administration's top health official today announced the
formation of a new task force to create a Web-based system of reporting
medical errors.
http://managedcare.medscape.com/36563.rhtml?srcmp=mc-042701
Read it Here
MANAGED CARE INDUSTRY/INSURERS
MOST HMOS SEEN POSTING STRONG PROFITS
Most US managed care firms are expected to report robust first-quarter
profit growth thanks to increases in premium prices, with the
conspicuous exception of the nation's No. 1 health insurer, Aetna Inc.,
whose results are likely to be dismal as it grapples with high medical
costs.
http://managedcare.medscape.com/36614.rhtml?srcmp=mc-042701
Read it Here
________________________________________________________________________
Visit the Money & Medicine home page for the latest healthcare business
stories. Go to http://moneymedicine.medscape.com
___________________ NEW FEATURE ARTICLES THIS WEEK ____________________
MENTAL HEALTH BENEFITS REMAIN LIMITED DESPITE FEDERAL PARITY ACT
Compliance with the 1996 law is associated with more benefit restrictions,
such as limits on office visits or hospital stays.
Drug Benefit Trends 12(7):5-9, BH, 2000
http://managedcare.medscape.com/26296.rhtml
Read it Here
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___________________________________ NEWS ______________________________
MANAGED CARE/INSURANCE COMPANIES
CHIROPRACTIC ORGANIZATION SUES HEALTH INSURER FOR UNFAIR DENIAL OF SERVICES
The Pennsylvania Chiropractic Association (PCA) announced on Wednesday that
it has filed a class-action lawsuit against Philadelphia-based Independence
Blue Cross and nine for-profit subsidiaries, accusing them of improperly
denying needed chiropractic care.
http://managedcare.medscape.com/26357.rhtml
Read it Here
CHIROPRACTORS SUE BLUES PLAN FOR RACKETEERING
Chiropractic groups on Friday charged Virginia's largest managed healthcare
company with illegally conspiring against the chiropractic profession by
imposing unfair payment terms for services.
http://managedcare.medscape.com/26105.rhtml
Read it Here
_______________________________________________________________________
_______________________________ MEMBER NEWS ___________________________
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UpToDate CLINICAL REFERENCE TOOLS NOW ON MEDSCAPE
Medscape members can now get select content from the UpToDate clinical reference library. UpToDate is the leading electronic clinical reference tool that thousands of clinicians rely on for instant, accurate answers to clinical questions. Each month, current topic reviews will be available on the Treatment Updates and Clinical/Surgical Management pages of Medscape. For more information and to sample this month's topics go to: http://medscape.com/medpulse/UpToDate
VISIT THE MOST COMPREHENSIVE DRUG RESOURCE ON THE WEB!
Medscape has combined two of the best drug databases on the web into one incredibly comprehensive resource! Medscape's newly redesigned DrugInfo database brings you the latest information from the National Drug Data File from FirstDataBank, and the American Hospital Formulary Service Drug Information reference from the American Society of Health-System Pharmacists (ASHP). Find information on drug-drug and drug-food interactions, uses and dosage, preparations, adverse effects, and four other categories for every drug. Patient education handouts are even available for printing and distributing at the time of prescription! Check out Medscape DrugInfo today, at DrugInfo
7/29/00
___________________________________ NEWS ______________________________
PHARMACISTS TAKE STAND AGAINST PILL SPLITTING
The trade group for senior-care pharmacists announced on Thursday that it
'strongly opposes' health insurance policies that require patients to split
tablets of medication to save money, because of the potential danger to
patients.
http://managedcare.medscape.com/25153.rhtml
Read it Here
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NEW RULES OUTLINE ANTI-FRAUD PROGRAMS FOR PHYSICIANS
The Office of Inspector General has outlined steps that solo and small
medical groups should take to
detect and eliminate health care fraud.
http://www.medscape.com/25168.rhtml
Read it Here
7/22/00:
___________________________________ NEWS ______________________________
WASHINGTON REPORT
AMA, SENATE REPUBLICANS SPAR OVER PATIENTS' RIGHTS House-Senate negotiations over a 'patients' bill of rights' remain at a standstill, but that has not quieted the war of words between the American Medical Association and Senate Republicans. http://managedcare.medscape.com/24803.rhtml Read it Here
CHIROPRACTIC GROUP GETS GREEN LIGHT TO SUE HHS A federal court has ruled that the American Chiropractic Association (ACA) may sue the US Department of Health and Human Services (HHS) over guidelines that the ACA says virtually exclude chiropractic services from the Medicare+Choice program. http://managedcare.medscape.com/24596.rhtml Read it Here
MANAGED CARE COMPANIES
HMOS UNVEIL PLANS FOR REBUILDING CONFIDENCE IN MANAGED CARE A coalition of major health plans and industry trade groups on Tuesday lifted the veil on a hush-hush initiative aimed at alleviating physicians' and patients' frustration with managed care. http://managedcare.medscape.com/24679.rhtml Read it Here
RESEARCH FINDINGS
PERCENTAGE OF US HEALTHCARE DOLLARS GOING TO MENTAL HEALTH TREATMENT DECREASES Just 7.8% of the more than $1 trillion spent on healthcare in the US in 1997 was spent on mental health and substance abuse treatment, down from 8.8% of total healthcare expenditures the decade before. http://managedcare.medscape.com/24671.rhtml Read it Here
STUDY CHALLENGES HMOS' ROLE AS MINORITY CARE BARRIERS It is widely believed that managed care organizations get a bad rap for making it difficult for ethnic or racial minorities to get the care they need. http://managedcare.medscape.com/24547.rhtml Read it Here
________________________________________________________________________
Visit the Money & Medicine home page for the latest healthcare business stories. Go to http://moneymedicine.medscape.com
_______________________________________________________________________ ___________________ NEW FEATURE ARTICLES THIS WEEK ____________________
Legal Issues EARLY EXPERIENCE WITH 'NEW FEDERALISM' IN HEALTH INSURANCE REGULATION HIPAA, the 1996 federal health insurance reform law, changed the way states can regulate health plans, but its implementation remains a work in progress, according to a new article in Health Affairs. http://moneymedicine.medscape.com/24523.rhtml Read it Here
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7/7/00: ___________________________________ NEWS ______________________________
WASHINGTON REPORT
HOUSE PASSES PHYSICIAN BARGAINING BILL
The House early Friday morning narrowly passed legislation that would grant
an exemption from federal antitrust laws to allow independent physicians to
band together to collectively bargain with insurance companies.
http://managedcare.medscape.com/23923.rhtml
Read it Here
US SENATE PASSES REPUBLICAN VERSION OF PATIENTS' BILL OF RIGHTS
Senate Republicans have again approved their own version of a patients'
bill of rights, signifying a hardening of positions in the prolonged battle
over how to regulate HMOs and other managed care plans.
http://managedcare.medscape.com/23926.rhtml
Read it Here
7/4/00
NATIONAL HEALTH INSURERS SUED FOR ERISA VIOLATIONS, RACKETEERING Some of the nation's largest managed care companies are the target of a new round of federal lawsuits for their alleged failure to disclose financial incentives to deny or limit medical care services. http://managedcare.medscape.com/23752.rhtml Read it Here
7/1/00
STUDY RAISES CONCERNS ABOUT FUTURE OF MEDICARE HMO PROGRAM Medicare HMO beneficiaries may end up paying more money for fewer health benefits if current trends continue, according to a study released on Monday at the annual meeting of the Association for Health Services Research (AHSR). http://managedcare.medscape.com/23705.rhtml Read it Here
6/24/00
___________________________________ NEWS ______________________________
HCFA EASES RULES FOR MEDICARE HMOS As scores of HMOs prepare to drop out of the Medicare program, the Health Care Financing Administration (HCFA) on Monday released long-awaited final rules easing some of the requirements for health plan participation. http://managedcare.medscape.com/23408.rhtml Read it Here
WHITE HOUSE TO SEEK INCREASE IN MEDICARE PROVIDER PAYMENTS President Clinton will propose boosting Medicare payments to hospitals, nursing homes and home healthcare agencies by $21 billion over 5 years, a Medicare official confirmed on Monday. http://managedcare.medscape.com/23399.rhtml Read it Here
INSPECTOR GENERAL PROBES RESULT IN NEARLY $1 BILLION PAYBACK Investigations by the Health and Human Services Office of Inspector General (OIG) resulted in the return of $968.1 million to the government in the first half of fiscal 2000. http://managedcare.medscape.com/23452.rhtml Read it Here
COURT UPHOLDS TEXAS 'RIGHT TO SUE' HMO LAW A federal appeals court has upheld a watershed piece of legislation that allows people in Texas to sue their HMOs. http://managedcare.medscape.com/23618.rhtml Read it Here
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>>> MEDSCAPE's Managed Care MedPulse(R) <<< http://managedcare.medscape.com
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___________________________________ NEWS ______________________________
DEMOCRATS OFFER PLAN FOR SOLVING CONFLICTS ON PATIENTS' RIGHTS MEASURE Democratic negotiators on Wednesday awaited reaction to a proposal addressing Republican concerns over employer liability for coverage decisions and other sticking points in House-Senate negotiations over the 'patients' bill of rights.' http://managedcare.medscape.com/22082.rhtml Read it Here
INSURERS, PHYSICIANS BATTLE OVER ANTITRUST BILL With an upcoming House vote on legislation that would provide self-employed physicians an exemption from federal antitrust laws so they can bargain collectively with insurance companies, both sides are ramping up their lobbying efforts. http://managedcare.medscape.com/21987.rhtml Read it Here
HIGH COURT RULING MAY SHIELD STATE HEALTHCARE PROVIDERS FROM FRAUD PENALTIES Private citizens, on behalf of Uncle Sam, may blow the whistle on state agencies for alleged fraud under the False Claims Act, but states are exempt from paying any penalties under that federal statute, the US Supreme Court ruled on Monday. http://managedcare.medscape.com/22083.rhtml Read it Here
COLUMBIA/HCA REACHES TENTATIVE SETTLEMENT WITH JUSTICE DEPARTMENT The US Justice Department and Columbia/HCA Healthcare Corp. announced on Thursday a tentative, $745 million partial settlement in connection with a 3-year federal investigation into alleged fraud at hospitals and other facilities operated by the company. http://managedcare.medscape.com/21877.rhtml Read it Here
9/99 News:
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SUPREME COURT TO RULE ON HMO LAWSUITS The US Supreme Court said on Tuesday that it would decide whether a patient can sue a healthcare provider under federal pension law when cost-saving measures influence treatment. http://managedcare.medscape.com/12469.rhtml Read it Here
CALIFORNIA LAW ALLOWS PATIENTS TO SUE HMOS Saying that it was time to take "cost-cutting bookkeepers" out of the healthcare business, Governor Gray Davis on Monday signed into law a package of California healthcare reforms, including one which gives patients the right to sue their HMOs. http://managedcare.medscape.com/12473.rhtml Read it Here
HOUSE REPUBLICANS UNVEIL INSURANCE ACCESS PLAN House Republicans Tuesday unveiled legislation aimed at helping the estimated 44 million uninsured Americans obtain coverage. http://managedcare.medscape.com/12472.rhtml Read it Here
AMA LAUNCHES SEARCHABLE DATABASE OF FULL-TEXT ARTICLES FROM THEIR JOURNALS All editorial material from The Journal of the American Medical Association (JAMA) and the American Medical Association's (AMA) Archives Journals is now available online through the AMA Publications Web site http://managedcare.medscape.com/12492.rhtml Read it Here
MOST AMERICANS FAVOR RIGHT TO SUE MANAGED CARE PLANS A majority of Americans favor the right to sue HMOs and managed care plans, and the majority also believe that such a right would increase the costs of health insurance, according to a Harris Poll released on Wednesday. http://managedcare.medscape.com/12536.rhtml Read it Here
From the APA:
>December 2, 1999
>FOR IMMEDIATE RELEASE
>CONTACT: Tricia Alvarez, 202-336-5910
>
10/00:
___________________ NEW FEATURE ARTICLES THIS WEEK ____________________
MANAGED CARE AND THE IMPERATIVE FOR A NEW PROFESSIONAL ETHIC A plan to address the growing misfit between traditional medical professionalism and emerging health care structures. Health Affairs 19(5):100-111,2000 http://managedcare.medscape.com/27497.rhtml Read it Here
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___________________________________ NEWS ______________________________
WASHINGTON REPORT
EMPLOYERS CONDEMN NEW VERSION OF MANAGED CARE BILL A new version of a so-called 'patients' bill of rights,' intended to appease those opposed to provisions to let patients sue their health plans, is actually worse than the bill that passed the House last year, a business group charged Tuesday. http://managedcare.medscape.com/27538.rhtml Read it Here
MANAGED CARE/INSURANCE INDUSTRY
HMO MEMBER SATISFACTION DECLINES Americans enrolled in HMOs reported an overall decline in their satisfaction with their health plan for the second year in a row, according to survey results released on Tuesday by Caredata.com. http://managedcare.medscape.com/27543.rhtml Read it Here
PLAN WEBSITES REACH OUT The Internet is a vital component of health plans' strategies to reach consumers, conduct transactions and improve provider relationships. http://managedcare.medscape.com/27426.rhtml Read it Here
US HEALTHCARE SYSTEM MISSING MOST MENTALLY ILL CHILDREN AND ADOLESCENTS More than 7 out of 10 American adolescents with mental health problems are getting no care, according to data released today at the Surgeon General's Conference on Children's Mental Health. http://managedcare.medscape.com/27553.rhtml Read it Here
GET THE MEDSCAPE TOOLBAR FREE! Medical research is easy with the new Medscape Toolbar. It's a faster, more efficient way to search our content and leading search engines. Don't miss out on the latest clinical information and medical research. Let the Medscape Toolbar save you time -- ahead of time. Download it for free, at http://www.athoc.com/wis/activate/default.asp?pid=13067&mktmsg=12
FREE ONLINE TRIAL OF UpToDate The UpToDate clinical reference is now on the web and you can try it FREE for the entire month of September at http://www.uptodate.com/Medscape. An official educational program of six major medical associations, UpToDate offers the fastest access to the most current, comprehensive clinical information and treatment recommendations.
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___________________________________ NEWS ______________________________
HOSPITAL PROFIT MARGINS' DOWNWARD SLIDE PUTS PROVIDERS AT RISK Hospital profit margins are being squeezed to the point that US hospitals may no longer have the financial flexibility to cope with declining reimbursements, a new analysis suggests. http://managedcare.medscape.com/21010.rhtml Read it Here
AMA PUSHES 'PATIENTS' BILL OF RIGHTS' IN TARGETED AD CAMPAIGN The American Medical Association on Tuesday took a swipe at the HMO lobby as it called on key lawmakers to support a stringent version of patients' rights legislation. http://managedcare.medscape.com/21022.rhtml Read it Here
KAISER PERMANENTE DROPS CONTROVERSIAL PSYCHIATRIC PRESCRIBING POLICY Kaiser Permanente, one of the largest not-for-profit HMOs in the country, announced that its Southern California medical group has dropped a controversial policy of allowing its psychiatrists to prescribe drugs for patients they have not seen. http://managedcare.medscape.com/21133.rhtml Read it Here
SEC SETTLES FRAUD CHARGES AGAINST AHERF OFFICIALS The US Securities and Exchange Commission earlier this week settled fraud charges against the former chief financial officer and other executives of the bankrupt Allegheny Health, Education and Research Foundation (AHERF). http://managedcare.medscape.com/21218.rhtml Read it Here
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________ NEW FEATURE ARTICLES THIS WEEK ____________________
Legal Issues PROTECTING PRIVACY ON-LINE Physicians face dual issues: How to safeguard your own personal data as well as that of your patients. http://moneymedicine.medscape.com/21192.rhtml Read it Here
MOVE TO OPEN MALPRACTICE DATA BANK Would patients be better served if they had access to the National Practitioner Data Bank? This question -- posed recently by a Congressional subcommittee -- has aroused a passionate response from patients, physicians and politicians who seek to balance a consumer's right to know with protections for the medical profession. http://moneymedicine.medscape.com/21193.rhtml Read it Here
LEGAL MATTERS - HEALTH INFORMATION CONFIDENTIALITY: THE FEDERAL GOVERNMENT STEPS IN Explore the provisions of the Department of Health and Human Services' proposed confidentiality regulations. Drug Benefit Trends 12(2):27-28,41-42, 2000 http://moneymedicine.medscape.com/21155.rhtml Read it Here
_______________________________________________________________________
_______________________________ MEMBER NEWS ___________________________
VISIT THE MOST COMPREHENSIVE DRUG RESOURCE ON THE WEB! Medscape has combined two of the best drug databases on the web into one incredibly comprehensive resourse! Medscape's newly redesigned DrugInfo database brings you the latest information from the National Drug Data File from FirstDataBank, and the American Hospital Formulary Service Drug Information reference from the American Society of Health-System Pharmacists (ASHP). Find information on drug-drug and drug-food interactions, uses and dosage, preparations, adverse effects, and four other categories for every drug. Patient education handouts are even available for printing and distributing at the time of prescription! Check out Medscape DrugInfo today, at http://www.medscape.com/druginfo For answers to frequently asked questions or technical support, go to: http://www.medscape.com/help/tech (Technical Support)
TECHNICAL SUPPORT & MEMBER HOTLINE 800-661-9789
___________________ NEW FEATURE ARTICLES THIS WEEK ____________________
MANAGED CARE MATTERS - DTC ADVERTISING: THE BIG FACE-OFF Is DTC advertising a patient education resource or a failing profit generator? Drug Benefit Trends 11(7):26, 1999 http://managedcare.medscape.com/12500.rhtml Read it Here
_______________________________________________________________________ ___________________________________10/99 NEWS ______________________________
THOMAS CALLS FOR END TO EMPLOYER-BASED INSURANCE SYSTEM The employer-based health care system in the United States is 'fatally flawed' and needs to be replaced, a leading health policymaker told the US Chamber of Commerce. http://managedcare.medscape.com/12957.rhtml Read it Here
___________________________________12/99 NEWS ______________________________
CALIFORNIA PENSION FUNDS CONSIDER DROPPING HEALTH PLANS Two of the biggest pension funds in California, the state which pioneered managed healthcare, are looking at cutting costs by contracting directly with doctors instead of health insurers, executives at the funds said. http://managedcare.medscape.com/15104.rhtml Read it Here
MANAGED MENTAL-HEALTH PLANS FOUND TO RELY ON ARBITRARY BENEFIT LIMITS Managed care's promise to control mental-health spending through sound medical decision making is not being fulfilled, results of a study suggest. http://managedcare.medscape.com/14948.rhtml Read it Here
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12/17/99 NEWS
______________________________ EMPLOYERS ARE ADDING HEALTH BENEFITS DESPITE RISING COSTS To keep workers happy in a tight labor market, US employers are sweetening health benefits packages even as the cost of providing that coverage is rising at a rate nearly triple that of general inflation, results of a new survey suggest. http://managedcare.medscape.com/15003.rhtml Read it Here
CALIFORNIA PENSION FUNDS CONSIDER DROPPING HEALTH PLANS Two of the biggest pension funds in California, the state which pioneered managed healthcare, are looking at cutting costs by contracting directly with doctors instead of health insurers, executives at the funds said. http://managedcare.medscape.com/15104.rhtml Read it Here
MANAGED MENTAL-HEALTH PLANS FOUND TO RELY ON ARBITRARY BENEFIT LIMITS Managed care's promise to control mental-health spending through sound medical decision making is not being fulfilled, results of a study suggest. http://managedcare.medscape.com/14948.rhtml Read it Here
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TREND OF THE MONTH - THE MAJOR REASON FOR RX SUBSTITUTION: LOWER COST Results from the Ortho Biotech 1999 Retail Pharmacy Digest survey indicate that lower costs were the primary reason for prescription substitutions. Drug Benefit Trends 11(11):11-12, 1999 http://managedcare.medscape.com/15281.rhtml Read it Here
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KAISER PERMANENTE DROPS DOCTOR BONUS PLAN Kaiser Permanente confirmed on Monday that it has stopped offering a 10% bonus to some newly trained physicians as an enticement to join its Northern California medical group. http://managedcare.medscape.com/15255.rhtml Read it Here
HEALTH PLAN PERFORMANCE VARIES WIDELY While HMOs, on average, are more efficient than indemnity plans and other forms of managed care, the performance of all types of health plans varies widely, according to the results of the 1999 Towers Perrin Health Plan Performance Benchmarking Study. http://managedcare.medscape.com/15305.rhtml Read it Here
This Week's MedPulse Sponsored by UPS
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DOCTORS UNION IS CERTIFIED AT PRIVATE PHILADELPHIA HOSPITAL Primary-care physicians at John F Kennedy Memorial Hospital in Philadelphia, Pennsylvania, have certified the Federation of Physicians and Dentists as their collective bargaining unit, union organizers announced on Monday. http://managedcare.medscape.com/15436.rhtml Read it Here
SECOND COLUMBIA/HCA EXECUTIVE SENTENCED TO PRISON A second executive of Columbia/HCA Healthcare Corporation was sentenced to prison on Wednesday for taking part in a scheme to defraud federal healthcare programs of $3 and a half million. http://managedcare.medscape.com/15340.rhtml Read it Here
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MEDSCAPE'S TIPS AND TRICKS MAKE YOU A WEB EXPERT! Are you new to Medscape, or to the internet in general? Do you want to know how to get the most from Medscape's vast features? Medscape is currently offering a FREE Tips and Tricks Newsletter! Learn how to optimize your search results, use our clinical calculators, create a free stock portfolio, and more! A different topic will be highlighted each week. Sign up today for Medscape's Tips and Tricks email newsletter at http://www.medscape.com/Home/misc/tips.cfm
_______________________________________________________________________ ___________________ NEW FEATURE ARTICLES THIS WEEK 1/8/00____________________
THE FUTURE OF HEALTH CARE Building a healthcare system for the 21st century will require a greater focus on safe, quality medical care, says Kaiser Foundation Health Plan CEO David M. Lawrence, MD. http://managedcare.medscape.com/15521.rhtml Read it Here
MANAGED CARE MATTERS - HOW IS AN HMO LIKE A DRUG COMPANY? (HINT: IT'S NOT.) Can imitating pharmaceutical companies' approach to public relations help change managed care's image? Drug Benefit Trends 11(11):27, 31, 1999 http://managedcare.medscape.com/15520.rhtml Read it Here
_______________________________________________________________________ ___________________________________ 1/8/00 NEWS ______________________________ HMOS WINS APPEAL IN CLASS ACTION CLAIM Aetna US Healthcare issued a statement saying a Court of Appeals had upheld dismissal of a claim that HMOs illegally withheld information about financial arrangements with physicians. http://managedcare.medscape.com/15586.rhtml Read it Here
JURY AWARDS $78 MILLION IN VERDICT AGAINST HUMANA A Palm Beach, Florida, jury has awarded more than $78 million in damages to plaintiffs in a civil case against Humana Inc. http://managedcare.medscape.com/15616.rhtml Read it Here
NCQA INITIATIVE DESIGNED TO BOOST COMPETITION AMONG HMOS As part of its Health Plan Employer and Data Information Set (HEDIS), the National Committee for Quality Assurance (NCQA) plans to require managed care organizations to report on patient LDL cholesterol levels. http://managedcare.medscape.com/15620.rhtml Read it Here
MASSACHUSETTS TAKES OVER CONTROL OF HARVARD PILGRIM HEALTH PLAN A Massachusetts judge placed Harvard Pilgrim Health Plan, the state's largest HMO, under state control after the HMO disclosed losses that were far greater than previously anticipated. http://managedcare.medscape.com/15629.rhtml Read it Here
LOWER-INCOME WORKERS CITE HEALTH INSURANCE COVERAGE GAPS American workers with job-based health insurance who make less than $20,000 a year are more likely than those in a higher-income bracket to lack coverage for preventive care and prescription drugs, results of a new survey show. http://managedcare.medscape.com/15510.rhtml Read it Here
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HEALTH PLAN GROUP COUNTERS REPORT FAULTING HMOS ON BEHAVIORAL HEALTH EFFORTS A recent report that found that HMOs fail to do enough to keep people healthy does not ring true, the American Association of Health Plans (AAHP) said. http://managedcare.medscape.com/16553.rhtml Read it Here
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>>> MEDSCAPE's Managed Care MedPulse(R) <<< http://managedcare.medscape.com >p> _______________________________________________________________________
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MANAGED CARE PLANS FLOUT LAWS TO PROTECT PATIENTS IN THE ER Managed care plans are dodging payment for care provided in emergency departments and skirting laws meant to ensure that patients get covered in emergency situations, according to reports in the March issue of the Annals of Emergency Medicine. http://managedcare.medscape.com/18226.rhtml Read it Here
WASHINGTON MATTERS - FEDERAL AND STATE LAWS AND REGULATIONS AFFECTING MANAGED CARE Despite the fact that most managed care plans specifically exclude coverage for participation in clinical trials, in practice they are picking up the bills. Drug Benefit Trends 11(12):17-18, 1999 http://managedcare.medscape.com/18433.rhtml Read it Here
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NCQA REPORT CARD LAUNCHES ON CBSHEALTHWATCH BY MEDSCAPE! Medscape now offers FREE access to the most comprehensive health plan report cards available anywhere! Check up on how your health plans compare to others in terms of access and service, care provided, and customer satisfaction. This valuable service is offered in partnership with the National Committee for Quality Assurance (NCQA), the nation's leader in assessing, measuring and reporting on quality of care provided by the nation's managed care organizations. Access the report cards today at http://cbshealthwatch.medscape.com/medscape/p/gcommunity/g10.asp.
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PATIENTS' RIGHTS DEBATE IGNORES KEY ISSUES, INSURANCE COMMISSIONERS CHARGE
Amid the tug and tussle of crafting a national patients' bill of rights, lawmakers have glossed over basic questions of how the law would be dovetailed with states' existing managed care regulations, state insurance commissioners charge. http://managedcare.medscape.com/19685.rhtml Read it Here
AMERICA'S HEALTHCARE 'SAFETY NET' IN DANGER OF COLLAPSING Public hospitals and clinics that care for America's poor and uninsured are being squeezed by an extraordinary confluence of financial and competitive pressures that could cause them to go out of business, according to a new report by the Institute of Medicine (IOM) released late on Thursday. http://managedcare.medscape.com/19691.rhtml Read it Here
HCFA SET TO PUBLISH OUTPATIENT PAYMENT RULES The Health Care Financing Administration (HCFA) on Friday will publish long-awaited final rules for implementing Medicare's new hospital outpatient reimbursement system. http://managedcare.medscape.com/19718.rhtml Read it Here
LONG-TERM CARE INSURANCE MARKET GROWS, BUT BUYER BEWARE When buying long-term care insurance, age, spousal discounts and inflation protection add-ons all affect premiums, a study by Weiss Ratings Inc. finds. http://managedcare.medscape.com/19787.rhtml Read it Here
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MEDICAL OFFICE MANAGEMENT DISCUSSION FORUMS Discuss hot topics with colleagues from across the nation! Join discussions on coding, reimbursement, legal, human resources, technology, patient satisfaction, marketing and other issues. Get started now, go to http://forums.medscape.com/home/network/mom/mom.html and check out our Coffee Talk section!
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Visit the Money & Medicine home page for the latest healthcare business stories. Go to http://moneymedicine.medscape.com
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KAISER ENLISTING PHYSICIANS TO IMPLEMENT PRACTICE GUIDELINES Knowing that physicians do not change their ways overnight, Kaiser Permanente is tackling the problem head on. Every time the HMO develops new guidelines, it dispatches its own physicians to act as implementation managers -- or, in other words, "change managers." http://www.medscape.com/19921.rhtml Read it Here
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CRITICS BLAST HMO INDUSTRY'S AD CAMPAIGN Managed care's leading trade association today will begin running a television spot that critics say could unravel efforts on Capitol Hill to pass a bill regulating health plans and providing patient protections. http://managedcare.medscape.com/19520.rhtml Read it Here
HOUSE COMMITTEE APPROVES PHYSICIAN ANTITRUST BILL The House Judiciary Committee Thursday overwhelmingly approved a bill that would provide an exemption from antitrust laws to allow independent physicians to bargain collectively with insurance companies. http://managedcare.medscape.com/19640.rhtml Read it Here
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Visit the Money & Medicine home page for the latest healthcare business stories. Go to http://moneymedicine.medscape.com
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Practice Management A ROAD MAP FOR MEDICAL PRACTICE SURVIVAL: Ignoring the business and customer service aspects of medicine can mean thousands -- sometimes millions of dollars -- in lost reimbursement, staff turnover and dissatisfied patients. http://managedcare.medscape.com/19645.rhtml Read it Here
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MEDICAL OFFICE MANAGEMENT DISCUSSION FORUMS
Discuss hot topics with colleagues from across the nation! Join discussions on coding, reimbursement, legal, human resources, technology, patient satisfaction, marketing and other issues. Get started now, go to http://forums.medscape.com/home/network/mom/mom.html and check out our Coffee Talk section!
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_______________________________ MEMBER NEWS ___________________________
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For answers to frequently asked questions or technical support, go to:
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39% OF DOCTORS SURVEYED REPORT MANIPULATING REIMBURSEMENT RULES TO HELP PATIENTS A random national sample of physicians showed that 39% report having manipulated reimbursement rules so patients can receive care that physicians perceive as necessary, according to a study in the April 12 issue of The Journal of the American Medical Association. http://managedcare.medscape.com/20148.rhtml Read it Here
FLORIDA REGULATOR MAY FINE TWO HMOS Florida treasurer and insurance commissioner Bill Nelson said last week that Physicians Healthcare Plans Inc. and United Healthcare of Florida Inc. face thousands of dollars in fines for violating the state's prompt payment law and that other plans can expect similar penalties. http://managedcare.medscape.com/19958.rhtml Read it Here
AETNA SETTLES SUIT WITH TEXAS ATTORNEY GENERAL Aetna Inc. said on Tuesday that it settled a lawsuit brought by the Texas attorney general alleging that the leading US health insurer misled customers in the state and offered illegal financial incentives to physicians to limit the costs of care. http://managedcare.medscape.com/20017.rhtml Read it Here
BUSH OFFERS HIS FIRST HEALTHCARE PROPOSAL OF CAMPAIGN Republican presidential candidate George W. Bush made his first foray into the healthcare debate on Tuesday, proposing a $39.6 billion plan to help 18 million low-income Americans buy insurance. http://managedcare.medscape.com/20021.rhtml Read it Here
BUSH CALLS FOR BOLSTERING AMERICA'S SAFETY NET Republican presidential candidate George W. Bush on Wednesday proposed strengthening America's healthcare 'safety net' through a $3.6 billion program to expand the number of community health centers nationwide and for additional federal support for underserved communities. http://managedcare.medscape.com/20059.rhtml Read it Here
KAISER DEFENDS MENTAL HEALTH COVERAGE AS 'TEAM-BASED'
Kaiser Permanente, under investigation in California for requiring
psychiatrists to write drug prescriptions for mental health patients whom
they have not seen, on Thursday defended its practice as 'team-based.' The
California State Department of Corporations is investigating Kaiser, the
nation's largest nonprofit health maintenance organization, after a
complaint from a psychiatrist who alleges that he was fired for refusing to
write prescriptions for patients he had not examined.
http://managedcare.medscape.com/20096.rhtml
Read it Here
ACCESS TO CARE NOT RESTRICTED IN HMOS Contrary to public perception, HMOs offer the same access to care and costly services as other types of healthcare plans, according to a report released today by the Center for Studying Health System Change. http://managedcare.medscape.com/18741.rhtml Read it Here
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SUPREME COURT HEARS PHYSICIAN INCENTIVE CASE
Lawyers for the managed care industry argued before the Supreme Court on Wednesday that a pending case, if upheld, could undermine the ability of managed care to contain costs. http://managedcare.medscape.com/18093.rhtml Read it Here
ACCESS PROVISIONS OF MANAGED CARE BILL SLAMMED Some 30 consumer groups on Thursday urged Congress not to include in a final version of the 'Patients' Bill of Rights' certain provisions that Republicans say would boost access to health insurance. http://managedcare.medscape.com/18201.rhtml Read it Here
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MANAGED CARE AGAIN TOPS STATE LAW LISTS Regulating the practices of managed care plans remained a top priority for state lawmakers in 1999, according to a survey released on Tuesday by the Blue Cross and Blue Shield Association. http://managedcare.medscape.com/17804.rhtml Read it Here
LAWYERS DISCUSS POTENTIAL IMPACT OF SUPREME COURT HMO CASE A pending Supreme Court case about whether physician incentives to withhold care can violate the federal Employee Retirement Income Security Act (ERISA) could have important ramifications for the industry, attorneys said Tuesday. http://managedcare.medscape.com/17806.rhtml Read it Here
GROUPS SAY CBO REPORT CONFIRMS HIGH PRICE OF RIGHT-TO-SUE MEASURE Health plan and insurance groups seized on a Congressional Budget Office report issued last Thursday as further evidence that a so-called patient protection bill, which expands patients' right to sue their managed care plans, is costly and unwise. http://managedcare.medscape.com/17722.rhtml Read it Here
PROPOSAL ABOUT CONFIDENTIALITY OF MEDICAL INFORMATION DRAWS PLAUDITS, COMPLAINTS The Clinton administration's proposed rules to protect the privacy of electronic medical information drew both praise and complaints from privacy advocates and healthcare industry officials at a House subcommittee on Thursday, the final day for the public to submit comments. http://managedcare.medscape.com/17958.rhtml Read it Here
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____________________ MEDICAL OFFICE MANAGEMENT NEWS ___________________
MEDSCAPE OFFERS EXPERT ARTICLES ON OFFICE MANAGEMENT TOPICS. Where can you go to get information that will help your practice improve its bottom line? Medscape Medical Office Management! In our Office Matters section, you'll find the latest on billing and collections, computers & technology, managed care, legislation that affects your practice, and much more. Check out Office Matters today, at http://medoffice.medscape.com
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